Revised TRAVEL REQUISITION

S TAT E U N I V E R S I T Y O F N E W Y O R K Req. # _______________________________

Office of Travel, Haggerty 302 Acct. # __________________ $ __________ *
Acct. # __________________ $ __________ *
Department_____________________________
Submit four (4) weeks prior to trip to allow for internal approvals, procedural compliance, and cost-effective trip planning. Send completed
original signed copy to Purchasing, HAB 307 and make a copy for your records. All requests for travel (over $200) must be submitted on this
form. Review travel policy at www.newpaltz.edu/travel. Attach additional documentation or itinerary if clarification of trip is necessary. All gray
areas must be completed prior to submitting this form and include purpose of the trip.

Name ____________________________________________________ Title _______________________________________________

Last First MI
Residence address: (remit to)__________________________________________________________________________________________
Street City State Zip

Departing address: (for actual trip) ______________________________________________________________________________________

Street City State Zip

Destination address: (the last business destination)___________________________________________________________________________

Street City State Zip
Departure ______________________ _________ AM PM Return _____________________ ________ AM PM
Date Time Date Time
Purpose for Trip ____________________________________________________________________________________________________

ANTICIPATED EXPENDITURES TOTALS PREPAID

BY STATE
REGISTRATION CREDIT CARD

Alternate Attendee Name (required if pre-paying) __________________________________ (550030) $ ______________

TRANSPORTATION
Rental Car: Confirmation #____________________ Location _______________________ (541500) $ ______________
Airfare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (542150) $ ______________
Train . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (542250) $ ______________
Car Pooled Bus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (540020) $ ______________
Personal Car mileage: _____________ miles @ $____________ /mileage rate . . . . . (543000) 0.00
$ ______________

LODGING (Over Per Diem )

Receipted (per diem) _____________ days x $____________ /day . . . . . . . . . . . . . (542040) 0.00
$ ______________
Un-receipted _____________ days x $____________ /day . . . . . . . . . . . . . (542000) 0.00
$ ______________

MEALS
Per Diem (overnight) _____________ days x $____________ /day . . . . . . . . . . . . . (542010) 0.00
$ ______________
$5/$12 (day trip) _____________ breakfast(s) @ $_______ . . . . . . . . . . . . . . . . . . . . (542030) 0.00
$ ______________
_____________ dinner(s) @ $_______ . . . . . . . . . . . . . . . . . . . . (542030) 0.00
$ ______________
INCIDENTAL EXPENSES
Parking $_________ Taxi $_________ Tolls/Bridges $_________ Subway $___________
Internet $__________ Gas $ _________ Other (explain) $_________ _________________ (540020) 0.00
$ ______________

TOTAL COST OF TRIP 0.00

$ ______________

*NOT TO EXCEED AMOUNT OF EXPENDITURE (Per department’s discretion) $ ______________

PREPAYMENTS REQUESTED (All requests required 30 days prior to travel):
Cash Advance (Requires advance form) (Min $100 – Max $400) Airfare Reimbursement (Requires pre-paid airfare form and paid receipt)
Registration (Requires registration form, employee must pre-register.) Lodging (Include confirmation number.) (non-employees)

Persons who travel before obtaining all approvals do so at their own risk and may not be reimbursed for their travel costs.
APPROVALS
__________________________________________________ ____________________________________________________
Traveler Date Traveler’s Supervisor Date
_______________________________________________ __________________________________________________
Authorized Account Signature (if different from supervisor) Date Authorized Out-of-State Signature Date

_______________________________________________ __________________________________________________
Authorized Account Signature (if additional accounts) Date
2/18 • 52-012